Fatal Black Fungal Infection In Covid Patients On Rise; Centre Issues List Of Dos And Don’ts

Covid Crisis: Black Fungus infection or ‘Mucormycosis’  is a serious infection being detected in patients who are or have suffered from the Covid 19 virus. The disease often manifests in the skin and also affects the lungs and the brain. With a number of mucormycosis cases detected in Delhi, Maharashtra, and Gujarat, experts in the national Covid-19 task force on Sunday issued an evidence-based advisory on the disease.

The government said in its advisory that is a fungal infection that mainly affects people who are on medication that reduces their ability to fight environmental pathogens, informing that the infection might turn fatal if not provided proper treatment. 

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The advisory further explained that ‘Mucormycosis’ usually infects the sinuses or lungs of such people after fungal spores are inhaled from the air. 

 Doctors in some states have noted a rise in cases of mucormycosis among people hospitalized or recovering from Covid 19, with some requiring urgent surgery. Usually, mucormycetes do not pose a major threat to those with a healthy immune system.

According to the advisory issued by ICMR, these are symptoms to detect if you are infected with the ‘Black fungus’

Symptoms

• Pain and redness around eyes and/or nose
• Fever
• Headache
• Coughing
• Shortness of breath
• Bloody vomits
• Altered mental status

When to suspect (in COVID-19 patients, diabetics or immunosuppressed individuals)

• Sinusitis – nasal blockade or congestion, nasal discharge (blackish/bloody), local pain on the cheek bone One sided facial pain, numbness or swelling
• Blackish discoloration over bridge of nose/palate
• Toothache, loosening of teeth, jaw involvement
• Blurred or double vision with pain; fever, skin lesion; thrombosis & necrosis (eschar)
• Chest pain, pleural effusion, haemoptysis, worsening of respiratory symptoms

DOs

• Control hyperglycemia
• Monitor blood glucose level post-COVID-19 discharge and also in diabetics
• Use steroid judiciously – correct timing, correct dose, and duration
• Use clean, sterile water for humidifiers during oxygen therapy
• Use antibiotics/antifungals judiciously

DON’Ts

• Do not miss warning signs and symptoms
• Do not consider all the cases with blocked nose as cases of bacterial sinusitis, particularly in the context of immunosuppression and/or COVID-19 patients on immunomodulators
• Do not hesitate to seek aggressive investigations, as appropriate (KOH staining & microscopy, culture, MALDITOF), for detecting fungal etiology
• Do not lose crucial time to initiate treatment for mucormycosis

How to prevent

• Use masks if you are visiting dusty construction sites
• Wear shoes, long trousers, long sleeve shirts and gloves while handling soil (gardening), moss or manure
• Maintain personal hygiene, including thorough scrub bath

Take a look at the advisory:

How to manage

• Control diabetes and diabetic ketoacidosis
• Reduce steroids (if patient is still on) with aim to discontinue rapidly
• Discontinue immunomodulating drugs
• No antifungal prophylaxis needed
• Extensive Surgical Debridement – to remove all necrotic materials
• Medical treatment

i) Install peripherally inserted central catheter (PICC line)

ii) Maintain adequate systemic hydration

iii) Infuse normal saline IV before Amphotericin B infusion

iv) Antifungal therapy, for at least 4-6 weeks (follow guidelines)

• Monitor patients clinically and with radio-imaging for response and to detect disease progression

Team approach

• Microbiologist
• Internal Medicine Specialist
• Intensivist Neurologist
• ENT Specialist
• Ophthalmologist
• Dentist Surgeon (maxillofacial/plastic)
• Biochemist

According to health experts, Mucormycosis (previously called zygomycosis) has been a cause of disease and death in transplants, ICU, and immunodeficient individuals for a long. However, it is a matter of serious concern that the cases of black fungal infections are on a rise in unsuspected Covid patients. Infact, Covid patients who have recovered from the virus are increasingly being pushed back into the ICUs due to Mucormycosis. Last year, the black fungus or Mucormycisis had caused high mortality with many patients suffering from loss of eyesight, removal of jawbones and nose.

 

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